Chronic Non-specific Lung Disease Research Articles

Pilot study to determine asthma-like symptoms in the Sverdlovsk region

Introduction. Bronchial asthma (BA) occupies one of the leading places in the structure of chronic nonspecific lung diseases in children. At an early age it develops in a relationship between genetic and environmental factors and often does not have a characteristic clinical picture. Allergic rhinitis (AR) increases the risk of developing and severity of asthma. Assessing the risk of developing BA and AR in children is necessary for timely diagnosis. Purpose of the study. To identify the prevalence of symptoms of bronchial asthma in children in the Sverdlovsk region using the example of Yekaterinburg and Nizhny Tagil using Russian versions of the Asthma Prediction Tool and ISAAC questionnaires and analyze the data obtained. Materials and methods. 64 children aged 6-8 years who did not have chronic lung diseases were studied: 30 people - in the Children's Hospital No. 8 of Yekaterinburg and 34 - in kindergarten No. 201 of Nizhny Tagil using Russified versions of the “Asthma Prediction Tool” and ISAAC questionnaires, filled out official representatives of children after informed consent to conduct the study. 64 correctly completed questionnaires were analyzed. Results. The proportion of children with an average and high risk of developing asthma: in Yekaterinburg 26.67%, in Nizhny Tagil - 35.29%. Symptoms of AR were detected in 60% of children from Yekaterinburg and in 82.35% from Nizhny Tagil, which is 2.5 and 1.6 times more common than the established diagnosis of AR, respectively. In Yekaterinburg, a high risk of asthma is associated with an allergic phenotype based on the frequency of concomitant atopic dermatitis (16.67% compared with 10% in the low-risk group, p = 0.0159) or its absence (63.33% and 10%, respectively, p= 0.0159), in Nizhny Tagil this relationship was not confirmed when tested by a two-sided Fisher test. The frequency of cases of hereditary predisposition to allergic pathology does not have significant differences between high (medium) and low risk groups in both cities. Conclusion. In Russia, 4.8 additional cases of asthma and status asthmaticus per 100 thousand children are associated with air quality. In 2021, the Sverdlovsk region is noted as one of the priority subjects of the Russian Federation in terms of the number of asthma diseases associated with the aerogenic factor in the environment of children. Although the observed trend in the predominance of cumulative symptoms of asthma and AR in children in Nizhny Tagil, in comparison with Yekaterinburg, is not statistically significant, it correlates with a higher level of aerogenic air pollution, this indirectly confirms the absence of a statistically significant relationship with a family history of allergic pathology. However, the connection with man-made pollutants is not taken into account in the ISAAC questionnaires. To confirm that the prevalence of asthma and AR symptoms is higher than those obtained in multicenter studies among children of a similar age, a survey of at least 350 people will be required. In any case, it is necessary to study the role of priority pollutants in the formation of airway hyperresponsiveness, asthma and AR, in order to find effective preventive measures.

Prognosis of the risk progression of post-inflammatory pneumofibrosis in children with chronic nonspecific lung diseases

Introduction. Pneumofibrosis (PF) is a morphological outcome of acute and chronic lung diseases, the progression of which leads to organ deficiency.Aim. Development of a prognostic algorithm for assessing the risk of progression of post-inflammatory PF in children with chronic nonspecific lung diseases (CNSLD).Materials and methods. The examination of 52 children with CNSLD with focal post-inflammatory PF was conducted, of which 26 children with progressive PF and 26 children with non-progressive PF. The children were selected according to the “case-control” scheme. The patients had a dynamic clinical and laboratory examination with multispiral computed tomography of the lungs. Determination of the “zero” genotypes of the detoxification genes GSTM1, GSTT1 was carried out by means of polymerase chain reaction. The odds ratio indicator was used to assess the relative risk.Results. Based on the analysis of medico-social, clinical characteristics and genetic polymorphism, an individual prognostic algorithm for the risk of progression of post-inflammatory PF in children with CNSLD was developed. The algorithm includes the calculation of the total score (TS) of 7 medical and social indicators (living in an urban area; the presence of passive smoking; the duration of a pulmonological history of 4-9 years; the presence of congenital lung malformation; the number of acute respiratory infections (ARI) 4 or more times/year; the duration of ARI 11 days or more; taking antibiotics for more than 3 once/year) and the presence of deletions in the detoxification genes GSTM1 and GSTT1. With a value of TS 6.97 or more, a high risk of progression of PF is predicted, with TS 3.47-6.96 points, a moderate risk of progression of PF is diagnosed, with TS 3.46 or less points, a minimal risk of progression of PF.Conclusion. The proposed algorithm allows predicting the risk of progression of post-inflammatory PF in children with CNSLD at the stage of early diagnosis and will prevent the spread of the process in the lungs with the help of preventive measures and preventive therapy, which will increase the duration and improve the quality of life of the patient.

Post-COVID syndrome in children with chronic nonspecific lung diseases

Aim. To determine the course features of the post-COVID syndrome in children with chronic nonspecific lung diseases (cystic fibrosis, congenital bronchial and lung malformations, asthma).
 Materials and methods. The study was conducted at the clinical base of the Department of Pediatrics and Pediatric Rheumatology of the Filatov Clinical Institute of the Sechenov University – National Medical Research Center for Children's Health from November 2020 to April 2023. The bi-directional single-center study included patients aged 1 month to 17 years 11 months who had a new coronavirus infection. The analysis included 69 patients with concomitant chronic nonspecific lung diseases: cystic fibrosis, congenital bronchial and lung malformations, and asthma. All patients were assessed at an average of 1 year (±2 months) after the new coronavirus infection using the ISARIC COVID-19 standardized questionnaire for children. The prevalence of post-COVID syndrome, the frequency of persistent symptoms, and the consequences of the new coronavirus infection in the group of children with concomitant chronic nonspecific lung diseases were determined. The rate of underlying disease exacerbations before and 1 year after COVID-19 was also retrospectively assessed.
 Results. One year after COVID-19 infection, patients with chronic nonspecific lung diseases do not consider themselves fully recovered from the disease and experience several persistent symptoms affecting various spheres of life: fatigue, physical activity, loss of appetite, as well as cognitive impairment, including difficulty concentrating, memory impairment, slip in speech, disrupting the daily life of the child and his family members and causing learning difficulties. To improve the quality of care for children with chronic nonspecific lung diseases who survived the COVID-19, programs for rehabilitation and treatment for post-COVID syndrome are needed, considering the possibility of developing both physical and neurocognitive disorders.

STUDY OF THE NATURE OF COUGH IN VARIOUS FORMS OF TUBERCULOSIS AND CHRONIC NONSPECIFIC LUNG DISEASES

The purpose of this study was to investigate the nature of cough in patients with different types of tuberculosis (TB) and chronic nonspecific lung diseases (CNSLD). A total of 120 patients were selected from the outpatient department of a tertiary care hospital in Tashkent, Uzbekistan, between September 2019 and December 2021. Cough nature was assessed by recording its duration, frequency, intensity, and associated symptoms. The results showed that patients with TB had a higher frequency and intensity of cough compared to those with CNSLD. Patients with pulmonary TB had a longer duration of cough compared to those with extrapulmonary TB. Patients with TB also reported more symptoms such as hemoptysis and fever. The findings suggest that a thorough assessment of cough nature in patients with TB and CNSLD can help in the early diagnosis and management of these diseases.

Comparative sensitivity of immunodiagnostic tests <i>in vivo</i> (Mantoux and RTA) and <i>in vitro</i> (QuantiFERON – GIT) in children with chronic nonspecific bronchopulmonary pathology associated with various tuberculosis

Aim. Selection and combination of immunodiagnostic tests to detect active tuberculosis (TB) in children with concomitant bronchopulmonary pathologies.Materials and methods. A prospective study of children and adolescents (n = 236) was conducted, which included cases with localized pulmonary tuberculosis; pulmonary tuberculosis associated with allergic or infectious and inflammatory forms of chronic nonspecific lung diseases (CNSLD); chronic nonspecific lung diseases under a significant absence of active TB but the presence of Mycobacterium tuberculosis. All patients underwent immunodiagnostic tests by Mantoux test, recombinant tuberculosis allergen (RTA) test, and QuantiFERON – GIT.Results. Mantoux and RTA tests were found to exhibit high sensitivity in children both with tuberculosis associated with concomitant pathologies and without such pathologies. Differences were observed in the results obtained by the Mantoux test in children with tuberculosis-associated bronchopulmonary pathology and those with localized tuberculosis. The Mantoux test may be positive as a result of many factors, other than active TB infection. Thus, children with allergic and infectious-inflammatory pathologies of the lungs exhibit an altered sensitivity to the Mantoux test. Such cases require in vitro diagnostics with the Quanti- FERON test, whose sensitivity is high despite the presence of CNSLD.Conclusions. Children with infectious-inflammatory CNSLD should undergo TB examination in stages based on in vivo and in vitro tests, when necessary. Children with allergic CNSLD should undergo in vitro tests at the first stage.

PROGNOSTIC SIGNIFICANCE OF CLINICAL AND LABORATORY FINDINGS IN THE NEW CORONAVIRUS INFECTION COVID-19

The new coronavirus infection COVID-19 is characterized by high mortality. The aim of the study was to establish the role of gender, age, concomitant diseases, shifts in laboratory findings in predicting fatal outcome in COVID-19 patients. The study was conducted on the basis of emergency medical care hospital (Cheboksary). 182 case histories of COVID-19 patients who underwent inpatient treatment were analyzed, 82 of whom died. The frequency of outcomes in different clinical conditions and laboratory shifts were analyzed, the relative risk (RR) of lethal outcome and its confidence interval were calculated. Mortality is naturally associated with the number of points on the NEWS 2 scale, the extent of pulmonary tissue involvement, no connection with gender was found. The prognostic value of acute kidney injury (RR – 2.57), chronic kidney disease (RR – 1.47), arterial hypertension (RR – 3.04), coronary heart disease (RR – 2.60), chronic nonspecific lung diseases (RR – 1.53), elderly and senile age (RR – 2.84, HR – 4.90), obesity of II-III degrees (RR – 1.97), body weight deficit (RR – 1.82) is shown. The ROC analysis method determined the levels of C-reactive protein in the blood (> 25 mg/l, RR – 3.2), an increase in procalcitonin (RR – 3.80), D-dimer (> 562.8 ng/ml, RR – 3.15), leukocytes (> 9.52×109/l, RR – 2.22), lymphocytes (< 1.15×109/l, RR – 2.04), interleukin-6 (> 13.2 pg/ml, RR – 3.38), fibrinogen (> 6.4 g/l, RR – 1.57), creatinine (> 91.8 mmol/l, RR – 1.95), lactate dehydrogenase (> 558 mmol/l, RR – 2.28), glomerular filtration rate (GFR < 63.8 ml/min / 1.73 m2, RR – 2.55), going beyond which significantly increases the risk of fatal outcome. Hence, along with the known factors in the high-risk group, it is necessary to take into account a specific body mass index, age group, renal function indicators and a number of inflammatory changes in the blood.

Relationship of specific and non-specific inflammation in children with respiratory tuberculosis and chronic lung diseases

The problem of the combination of tuberculosis and chronic nonspecific diseases of the bronchopulmonary system in children and adolescents has not been sufficiently studied to date and remains relevant.Purpose. The study aims at determination of predictors of tuberculosis infection to identify groups at high risk of developing tuberculosis among children with chronic nonspecific pathology.Materials and research methods. A prospective study of children and adolescents (n = 158) with isolated respiratory tuberculosis and its combination with various forms of chronic obstructive pulmonary disease (lung defects, chronic bronchitis, bronchial asthma) was conducted. These two groups were compared in respect of the medical history and physical examination data, as well as computed tomography findings.Results. The predictors of the development of tuberculosis included cases of pneumonia at an early age, acute respiratory infections 3 or more times a year, and the early age of children infected with Mycobacterium tuberculosis.Conclusion. These conditions increase the risk of developing active tuberculosis in children and cause its more severe course. In addition, chronic nonspecific lung diseases associated with tuberculosis often complicate the course of a specific process and are often characterized by recurrent attacks.

Indicators of lung function in children with chronic nonspecific lung diseases with pulmonary fibrosis

Introduction. The pathogenesis of most chronic nonspecific lung diseases (CNSLD) in children is based on a long-term inflammatory process, often leading to the formation of pulmonary fibrosis in the structurally altered tissue, which requires dynamic monitoring of patients, including the study of lung function.Aim. To assess the indicators of the lung function in children with chronic bronchopulmonary pathology accompanied by pulmonary fibrosis.Materials and methods. 84 children with CNSLD were examined. The main group consisted of 45 children with CNSLD with pulmonary fibrosis (bronchopulmonary dysplasia, congenital malformations of the lungs, chronic bronchitis, and post pneumonia fibrosis). The comparison group consisted of 39 children with CNSLD without pulmonary fibrosis. The average age of children in the study groups was 9,3±0,48 years. The patients underwent multispiral computed tomography of the lungs with a virtual bronchoscopy program and intravenous bolus contrast enhancement. Evaluation of lung function was carried out by spirometry.Results. In patients in remission, the average values of the ventilation capacity of the lungs in both groups were within the predicted values. However, in patients with fibrotic changes, pulmonary dysfunction was detected 2 times more often than in children with CNSLD without pulmonary fibrosis (35.5% and 15.4%, respectively, p<0.05). Restrictive ventilation disorders were diagnosed only in the group of patients with pulmonary fibrosis. In children with pulmonary fibrosis, the risk of reduced ventilation capacity is significantly higher than in children with CNSLD without pulmonary fibrosis (OR=3.04, 95% CI 1.049–8.78).Conclusion. The data obtained can serve as a prerequisite for further development of predicting the nature of the course of the disease, identifying “risk groups” for the development of fibrotic changes for a personalized approach to the treatment and follow-up of patients with CNSLD.

Chronic bronchitis in the practice of a family doctor

Chronic bronchitis is the most common chronic nonspecific lung disease (CNSLD). The prevalence of chronic bronchitis in the Russian Federation ranges from 10 to 20%, and the increase in the incidence of chronic nonspecific lung diseases is 6–7% for the urban and 2–3% for the rural population per year. The recent increase in the incidence of bronchitis in most countries of the world is associated with air pollution with dust particles and gases, the popularity of smoking, and allergies of the population. The article tells about the modern principles of diagnosis and treatment of chronic bronchitis. Particular attention is paid not only to the optimal choice of antibiotic therapy for infectious exacerbation of chronic bronchitis (CB), but also to the role of topical antibacterial drugs (ABD) in this case. The basic points outlined in the article can be useful for general practitioners and pulmonologists who are faced with this disease.

Blood changes in chronic nonspecific lung diseases under the influence of hemotherapy

We observed 50 patients aged 15 to 70 years. There were 15 people with prolonged acute pneumonia, 15 with bronchial asthma, 11 with chronic interstitial pneumonia, 9 with pneumosclerosis. There were 23 men, 27 women. Patients with chronic interstitial pneumonia also suffered from bronchiectasis, often multiple, with periodic exacerbations. Bronchial asthma in 15 people was accompanied by severe attacks in recent years, in a number of patients it was complicated by pneumosclerosis in the stage of emphysema and bronchiectasis.

Hemodynamics of the small circle in chronic nonspecific lung diseases

Hemodynamic disorders in the pulmonary artery system are leading in the development of the pulmonary heart, however, it is often not possible to identify them based on clinical symptoms and generally accepted methods of examination (X-ray, ECG, etc.).

Patients with non-tuberculous mycobacteriosis in clinical practice

Incidence and prevalence of non-tuberculous mycobacteriosis (NTM) are recorded in many countries, but the rates vary. There are no official statistics on the prevalence and incidence of NTMs in the Russian Federation at the moment. The regulatory and expert clinical database for NTMs has not yet been developed. The aim of thе article is to share the experience of the Federal State Scientific Institution “Central Research Institute of Tuberculosis” (FSSI “CRIT”) in working with patients with NTMB over the past 7 years. Methods. The study included 190 patients with a confirmed diagnosis of NTMB who were treated at the FSSI “CRIT” in 2011 – 2018. Before the diagnosis of NTMB, all patients were followed for a long time by various specialists (pulmonologists, general practitioners) for various chronic respiratory diseases. NTMs were isolated from the diagnostic material by the culture method. The material was inoculated into a liquid medium in an automated BACTEC MGIT 960 system and into Levenshtein – Jensen dense medium until the culture growth was obtained. The HTM species was determined using DNA strips GenoType® Mycobacterium CM by Hain Lifescience (Germany). Results. More than half of the examined patients were registered with a phthisiatrician for various clinical forms of pulmonary tuberculosis (disseminated, fibro-cavernous, focal). In 85.6% of cases, no MBT DNA was found in the sputum and skin tests with recombinant tuberculosis antigen (Diaskintest®) were negative. Nevertheless, the changes in the lungs detected on the chest CT and even a single detection of acid-fast microorganisms (AFB) without typing led to an erroneous diagnosis of tuberculosis. In some patients (6.8%), a combination of pulmonary tuberculosis and NTMB was diagnosed. Bronchiectasis and COPD were the most common chronic nonspecific lung diseases. 66.7% of the patients had centrilobular foci characterized by the involvement of not only the bronchial wall but also the pulmonary vessels. NTMB resistance to a wide range of antibacterial drugs was determined in 118 patients (out of 190). The prolonged use of chemotherapy drugs revealed a wide range of drug intolerance. Side effects were handled in various ways: drug replacement (with consideration to the sensitivity), temporary withdrawal, and drug discontinuation. Conclusion. This work reflects the long-term experience of the FSSI “CRIT” staff with patients with NTMs, which can be used in creating national recommendations on NTMs.

The clinical significance of the determination of sialic acid and protein fractions in chronic nonspecific lung diseases

In the domestic and foreign literature available to us, we did not find data on the content and dynamics of sialic acid in chronic nonspecific lung diseases. In this regard, we decided to conduct observations and compare the results obtained with the clinical picture and such indicators of the inflammatory process as ROE and the number of leukocytes, as well as with protein fractions, which were determined by electrophoresis on paper.

Oximetric studies in chronic nonspecific lung diseases

Oximetric studies were carried out in 48 patients, of whom 18 were with chronic emphysema of the lungs, pneumosclerosis with circulatory failure of 2 and 3 degrees (cor pulmonale II).

Клинико-рентгенологические проявления микобактериоза у больных с хроническими заболеваниями легких

Study Objective: to identify clinical and X-ray features of mycobacteriosis caused by slow-growing forms of nontuberculous mycobacteria (NTMB), in patients with chronic non-specific lung diseases and TB. Study Design: prospective and retrospective study. Materials and Methods. We examined 166 patients with chronic lung diseases: bronchitis, obstructive respiratory diseases, bronchiectatic disease, and TB. 79 patients had a primary disease and nontuberculous mycobacteriosis (NTM); controls were 87 patients without NTM. The study included only patients with slow-growing forms of NTMB. Study Results. Analysis of the clinical presentations demonstrated that, when associated with chronic lung diseases, a mycobacterial infection did not cause severe aggravation of clinical symptoms of the disease, except for TB. All study groups showed identical X-ray symptoms: fibrous, focal infiltrative, cavity changes, and bronchictasia. Still, most often they were recorded in patients with NTM. Conclusion. NTM caused by slow-growing forms of NTMB is diagnosed in long-lasting chronic non-specific lung diseases without aggravated clinical symptoms of the disease. When associated with the tuberculous process, a mycobacterial infection makes clinical symptoms more pronounced, but the duration of the disease remains the same. Excessive fibrosis is noted on CT scans, and main functional parameters get worse. Keywords: nontuberculous mycobacteriosis, chronic non-specific lung disease, TB.

THE BRONCHOPULMONARY SYSTEM DAMAGE UNDER THE INFLUENCE OF IONIZING RADIATION EXPOSURE AND RADIONUCLIDES INHALATION IN THE CONDITIONS OF THE CHORNOBYL CATASTROPHE (SUMMARIZING OF 35 YEARS RESEARCH EXPERIENCE).

The review is devoted to the summarizing of 35 years of research of ionizing radiation exposure and radionuclidesinhalation influence on the bronchopulmonary system of clean-up workers of the Chornobyl NPP accident. Radiationand hygienic preconditions for the formation of chronic respiratory pathology are considered, taking into accountthe dosimetric data of irradiation of the bronchopulmonary system.The main clinical symptoms, features of disorders of pulmonary ventilation capacity and endoscopic forms of lesionsof the bronchopulmonary system of participants in the liquidation of the accident were determined.On the basis of pathomorphological, microbiological and immunological researches the pathomorphosis of chronicnonspecific lung diseases in the conditions of the Chernobyl catastrophe is proved.It is proved that under combined influence of external irradiation and inhalation of a fragmentary mixture ofradionuclides in the condition of the Chernobyl catastrophe, the bronchopulmonary system has become one of themain «targets»-tissues, of realization of stochastic and nonstochastic effects.

Comparative evaluation of pre-infusion at caesar section performed under spinal anesthesia. Results of multicenter trial

Abstact. Study of the effect of preinfusion, various infusion solutions on the state of hemodynamics, in patients undergoing a cesarean section performed under spinal anesthesia with 0.5 % solution of Longocain Heavy (0.5 % hyperbaric bupivacaine).Materials and methods. Spinal anesthesia (SAN) was performed in 2 190 women, aged 21 to 39 years, with a gestational age of 39 to 40 weeks. The structure of extragenital pathology was dominated by chronic anemia of varying severity – 1 650 (75.3 %), urinary tract infections – 756 (34.5 %), mild preeclampsia – 245 (11.2 %), chronic nonspecific lung diseases – 125 (5.7 %). 1 786 (81.5 %) patients underwent surgery in a planned manner, according to emergency indications – 404 (18.4 %). A combination of the two pathologies was observed in 852 (38.9 %) women. Indications for surgery were: disease of the operated uterus, insolvency of the scar on the uterus, clinically narrow pelvis, high-grade myopia, secondary labor weakness. The duration of surgery is ranged from 40 to 52 minutes.Results. In group I, the expressed hypotension, requiring sympathomimetic support with mezaton was observed in 192 (34.8 %) patients. In group II, severe hypotension requiring sympathomimetic support with mezaton was observed in 114 (20.8 %) patients. And in group III, hypotension requiring sympathomimetic support with mezaton was observed in 127 (23.2 %) patients. At that time, in patients of group IV severe hypotension, requiring sympathomimetic support with mezaton was observed in only 91 (18 %) cases.Conclusions. Neuraxial anesthesia is accompanied by the development of hypotension, which can be prevented by preinfusion with crystalloid solutions. Aggressive preinfusion of large volumes of isoosmolar crystalloids at a dose of 10–14 ml/kg was associated with an increase in the frequency of hemodynamic instability requiring sympathomimetic support.

Polymorphisms of xenobiotic biotransformation genes of the glutathione-S-transferase family (GTSS) (review)

Introduction. In modern pulmonology, chronic non-specific lung diseases are considered as multifactorial diseases. They are based on increased sensitivity to environmental factors. A significant role in the manifestation of lung diseases is played by genetic component, in particular, xenobiotic biotransformation enzyme genes of the glutathione-s-transferase family (GSTS). Glutathione-s-transferases (GST) are a family of enzymes involved in detoxification. Genes encoding the proteins GSTA1, GSTM1, GSTP1 and GSTT1 are polymorphic, this can lead to complete or partial loss of enzyme activity and be a predisposing factor for the development of various pathological changes in sensitive people. Aim. A review containing data on the association of the risk of developing lung diseases in carriers of polymorphic genes encoding the second phase enzymes of the xenobiotic detoxification system of the glutathione transferase family to present the current state of the issue, to understand the direction of research and unresolved problems. Materials and methods. There was made an analysis of publications containing the results of a study of the association of the risk of lung diseases in carriers of polymorphisms of xenobiotic biotransformation genes of the GTSS family. Results. The analysis data indicate the association and adverse effect of functionally defective alleles of the genes of the glutathione-s-transferase family (GSTM1 (0), GSTP1 (s) and GSTT1 (0)) on the course of bronchial asthma. The results of studies on the associations of various variants of genetic polymorphism and the development of bronchial asthma are associated with the differential sensitivity of people to various environmental factors, the presence of ethnic differences, combinations of functionally defective variants of several genes. Conclusion. Evaluation of the role of polymorphisms of xenobiotics biotransformation genes in the study of phenotypes of lung disease in children helps to improve and optimize diagnostic and therapeutic measures.

Specific course of tuberculosis in elderly and senile patients

The objective: to identify specific features of the clinical course of tuberculosis in elderly and senile patients under the current epidemic situation.The specific clinical course of tuberculosis was analyzed in 54 patients at the age of 61 years and older and compared with the course of 234 patients at the age from 18 to 39 years selected by the continuous sampling of all 472 patients discharged from hospital in 2018. The following features were found to be typical of patients of 61 years and older: more frequent chronic forms of the disease (37.0%) and complications (35.2%), the major complication was chronic cor pulmonale (33.3%); more frequent concurrent chronic nonspecific lung diseases (13.0%) and coronary heart disease/arterial hypertension (14.8%); more frequent deaths (31.5%), mainly due to pulmonary heart disease; less frequent generalization of tuberculosis (5.5%) and concurrent HIV infection (7.4%).

THE CAUSES OF ADVERSE TREATMENT RESULTS AND THE WAYS OF THEIR ELIMINATION IN BLEEDING FROM CHRONIC GASTRODUODENAL ULCERS

The aim: Is to determine the main causes of adverse outcomes of the patients' treatment with acute ulcerative gastroduodenal bleeding and to develop preventive measures to improve the quality of the patients' treatment with this pathology. Materials and methods: A retrospective analysis of the treatment results of 1323 patients with bleeding of ulcerative etiology has been carried out. There are 375 patients with gastric ulcer (28.3%) and 948 patients (71.7%) with duodenal ulcer among them. The patients' age ranged from 15 to 93 years old. Concomitant pathology was observed in 623 (47.1%) patients, the most common of which were coronary heart disease, chronic non-specific lung diseases and cerebrovascular diseases. Mild severity of blood loss was detected in 404 (30.5%) patients, moderate severity 693 (52.5%), severe 145 (10.9%) and extremely severe 81 (6.1%). Overall mortality was 5.9%, postoperative mortality 6.3%, the mortality in conservative treatment only 6.1%. Results: The main cause of the patients' mortality with acute ulcerative gastroduodenal bleeding was decompensated hemorrhagic shock which developed at the prehospital stage in 45.3% and as a result of bleeding recurrence during treatment 44.2% of the patients. Inadequate drug therapy increases the risk of bleeding recurrence from 15.8 to 32.7%. The use of proton pump blockers and the combination of bolus and prolonged use of proton pump blockers allow to reduce the risk of bleeding recurrence by half (up to 6.8%). Conclusions: Endoscopic hemostasis in combination with the injection method with diathermocoagulation or thermal coagulation can be considered as full-fledged, and when performing endoscopic monitoring the preference should be given to coagulation methods of diathermo- and hydrodietermocoagulation.